Medicare Agent Restrictions: What You Need to Know

Published on September 18, 2021

Medicare plan sales offer agents an exciting and rewarding career path to serve an important and growing demographic. Because the senior population is especially vulnerable to predatory sales tactics and fraud, Medicare agents have detailed guidelines to follow.

What Are Medicare Marketing Restrictions?

Medicare marketing restrictions apply specifically to agents or brokers selling Medicare plans and are followed in addition to other insurance sales regulations.

CMS (Centers for Medicare & Medicaid Services) outlines general rules for Medicare plan representatives in their interactions with senior clients. The following are some of the rules that apply to any Medicare Advantage or Medicare Part D sales interaction. For instance, Medicare sales agents cannot:

  • Make unsolicited calls to prospects (cold calls).
  • Sell life insurance, annuities, or other non-health related products in the same sales presentation as a Medicare plan.
  • Pitch plans in places where people already receive healthcare.
  • Offer clients gifts valued at over $15 for enrolling in their plan or offer cash rewards of any value.
  • Provide free meals during a Medicare product pitch.

Appointment Rules and Scope of Appointment

Appointments for pitching Medicare plans must have a Scope of Appointment. A Scope of Appointment (SOA) is a document that explicitly outlines what plan the client authorized the agent to discuss, and prevents an agent from pitching plans to a client that were not previously requested. SOAs are required for every face-to-face meeting and one-on-one phone conversations.

If your client requests information outside of the SOA during an appointment, the agent must fill out another SOA with that request. Medicare agents must also keep SOAs on file for ten years.

Educational and Sales Events

Educational events are events specifically advertised as providing Medicare information. At these events, agents cannot distribute or discuss anything related to a specific plan. Attendees cannot be required to sign in for the event. However, agents are permitted to give their business cards and schedule future sales appointments.

For a sales event, agents cannot use pressure or threats to get attendees to sign up for a plan. The use of superlative statements such as “best plan” or “number one” is prohibited. Agents are permitted to hold a sales event immediately after an educational event, provided the audience is informed that the event’s purpose is shifting to sales. Furthermore, members of the audience are permitted to leave before the sales event begins.

Open Enrollment Period

Medicare’s Open Enrollment Period (OEP) from January 1st to March 31st is a period when Medicare recipients can change their Medicare Advantage plan, move from a Medicare Advantage plan to Original Medicare, or drop their Medicare Part D prescription drug plan. During OEP, agents are not allowed to knowingly or intentionally market to Medicare Advantage or Medicare Part D enrollees. 

(NOTE: OEP is not to be confused with AEP (Annual Enrollment Period), which runs from October 15th to December 7th and allows for more plan changes. Brokers are allowed to market Medicare Advantage plans during AEP.

Final Thoughts

Having a firm understanding of the compliance regulations for Medicare plans is critical to protecting your senior clients and your insurance license. This article is not an exhaustive list. Seek guidance from a reputable, seasoned Medicare insurance provider before starting your Medicare sales career.

How Do I Learn More?

For more information about selling insurance policies to seniors, contact the specialists at American Senior Benefits. Our licensed professionals can help with any of your questions.  

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